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A Case of Heyde Syndrome with Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement.
Am J Case Rep 2018; 19:924-926AJ

Abstract

BACKGROUND

Heyde syndrome is the association between gastrointestinal (GI) bleeding from arteriovenous malformation (AVM) and aortic stenosis. The aim of this study was to review Heyde syndrome and to discuss the management of this condition. CASE REPORT A 56-year-old female with a history of severe aortic stenosis and recurrent GI bleeding secondary to small bowel AVM, presented for hospital admission with melena and maroon blood in her stool. The patient underwent esophagogastroduodenoscopy with push enteroscopy, full colonoscopy, and mesenteric angiogram with failure to identify any active bleeding sources. Her hemoglobin continued to drop, requiring daily transfusion of packed red blood cells (PRBCs). Von Willebrand factor (VWF) antigen was low at 37%, and VWF large multimers were low and consistent with acquired VWF disease. The patient was then transferred to a tertiary care center and underwent transcatheter aortic valve replacement. Two weeks after discharge, she presented again with an episode of melena, with hemoglobin of 7.6 gm/dL and hematocrit of 25.1%. She was transfused 4 units of PRBCs and monitored for 48 hours, and then discharged without further episodes of GI bleeding. At the 2-month follow-up, she had stable hemoglobin at 15.1 gm/dL without further episodes of GI bleeding. At the 6-month follow-up she showed stable hemoglobin at 14.3 gm/dL without further episodes of GI bleeding.

CONCLUSIONS

Physicians need to consider Heyde syndrome in patients with aortic stenosis and GI bleeding secondary to angiodysplasia. Physicians should also be attentive in patients with Heyde syndrome presenting with GI bleeding after undergoing aortic valve replacement, as GI bleeding might take time to resolve completely in these patients.

Authors+Show Affiliations

Department of Internal Medicine, North Bay Medical Center, Fairfield, CA, USA.Department of Gastroenterology, North Bay Medical Center, Fairfield, CA, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30082678

Citation

Alshuwaykh, Omar, and Michael J. Krier. "A Case of Heyde Syndrome With Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement." The American Journal of Case Reports, vol. 19, 2018, pp. 924-926.
Alshuwaykh O, Krier MJ. A Case of Heyde Syndrome with Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement. Am J Case Rep. 2018;19:924-926.
Alshuwaykh, O., & Krier, M. J. (2018). A Case of Heyde Syndrome with Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement. The American Journal of Case Reports, 19, pp. 924-926. doi:10.12659/AJCR.911298.
Alshuwaykh O, Krier MJ. A Case of Heyde Syndrome With Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement. Am J Case Rep. 2018 Aug 7;19:924-926. PubMed PMID: 30082678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Case of Heyde Syndrome with Resolution of Gastrointestinal Bleeding Two Weeks After Aortic Valve Replacement. AU - Alshuwaykh,Omar, AU - Krier,Michael J, Y1 - 2018/08/07/ PY - 2018/8/8/entrez PY - 2018/8/8/pubmed PY - 2018/10/26/medline SP - 924 EP - 926 JF - The American journal of case reports JO - Am J Case Rep VL - 19 N2 - BACKGROUND Heyde syndrome is the association between gastrointestinal (GI) bleeding from arteriovenous malformation (AVM) and aortic stenosis. The aim of this study was to review Heyde syndrome and to discuss the management of this condition. CASE REPORT A 56-year-old female with a history of severe aortic stenosis and recurrent GI bleeding secondary to small bowel AVM, presented for hospital admission with melena and maroon blood in her stool. The patient underwent esophagogastroduodenoscopy with push enteroscopy, full colonoscopy, and mesenteric angiogram with failure to identify any active bleeding sources. Her hemoglobin continued to drop, requiring daily transfusion of packed red blood cells (PRBCs). Von Willebrand factor (VWF) antigen was low at 37%, and VWF large multimers were low and consistent with acquired VWF disease. The patient was then transferred to a tertiary care center and underwent transcatheter aortic valve replacement. Two weeks after discharge, she presented again with an episode of melena, with hemoglobin of 7.6 gm/dL and hematocrit of 25.1%. She was transfused 4 units of PRBCs and monitored for 48 hours, and then discharged without further episodes of GI bleeding. At the 2-month follow-up, she had stable hemoglobin at 15.1 gm/dL without further episodes of GI bleeding. At the 6-month follow-up she showed stable hemoglobin at 14.3 gm/dL without further episodes of GI bleeding. CONCLUSIONS Physicians need to consider Heyde syndrome in patients with aortic stenosis and GI bleeding secondary to angiodysplasia. Physicians should also be attentive in patients with Heyde syndrome presenting with GI bleeding after undergoing aortic valve replacement, as GI bleeding might take time to resolve completely in these patients. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/30082678/A_Case_of_Heyde_Syndrome_with_Resolution_of_Gastrointestinal_Bleeding_Two_Weeks_After_Aortic_Valve_Replacement_ L2 - https://www.amjcaserep.com/download/index/idArt/911298 DB - PRIME DP - Unbound Medicine ER -